Chronic Suppurative Otitis Media (CSOM): Symptoms & Treatment

Oct 8, 2024

CSOM: Chronic Suppurative Otitis Media

Chronic: Disease lasts for more than 12 weeks.
Suppurative: Pus
Otitis media: Pus is in the middle ear.
Long - standing infection in middle ear cleft lead to discharges & permanent perforation.

What is Permanent Perforation?

Perforation is permanent when the edges of the perforation are covered by stratified squamous epithelium and do not heal spontaneously.

Perforation

Tubotympanic Perforation

The disease begins at the eustachian tube and goes to the middle ear cavity.

Seen in younger age groups.
Due to nasal or nasopharyngeal pathology
Antero inferior part of the middle ear gets affected.

Atticoantral Perforation

The disease begins in the attic and goes posteriorly into the mastoid air cells.

Seen in older people.
Occurs secondary to cholesteatoma
Posterosuperior part of the middle ear gets affected

Tubo-Tympanic	Atticoantral
Profuse pus, resulting in perforation of pars Tensa	Scanty pus, resulting in perforation of pars flaccida
Non-foul smelling	Foul-smelling pus as it involves bone
Non Blood stained	Blood stained pus
Antero inferior part of the middle Ear	Involves the posterosuperior part of the middle ear is affected
Hearing loss present.	The hearing loss is higher.
Complications are rare.	Complications such as - Tegmen erosion - Ossicular erosion - Osteitis and granulation - Facial nerve erosion

Signs & Symptoms & Complications

Examination of CSOM

Examine the ear : to check for permanent perforation.
Evaluate Pathology: In the nose, nasopharynx or palate; Diagnostic nasal endoscopy or CT scan of the nose and paranasal sinuses can be done.
High-resolution CT scan of the temporal bone: To evaluate the extent of erosion.
Audiological Evaluation: To evaluate the degree of hearing loss.

	Tubo-tympanic	Attico-antral
Cause	Tubal cause, ASOM, allergy (in children)	Cholesteatoma
Age	Children	Adults
Perforation	Central	Attic
Area involved	Antero-inferior	Posterior -superior
Discharge quantity	Profuse	Scanty
Cholesterol granuloma	rare	common
Bone destruction	Rare	Common of annulus, tympanic bone, ossicules, tegmen tympani
Discharge smell	Odourless & mucoid	Foul & purulent
Osteitis & granulation tissue	rare	Common
Ossicular necrosis	Mild-moderate	Common
Hearing loss	Rare	Moderate to severe
Tegmen tympani erosion	Rare	Common
Intracranial complications	Rare	Common
Polyp	Pale	Red,fleshy
Safe/unsafe	Safe	Unsafe
Tympanosclerosis	Common	Rare

Diagnostics

Examination under Microscope - very important
Audiogram: To assess the hearing loss degree
Culture and sensitivity of the ear discharge.
Mastoid X ray - sclerotic and extent of bone destruction.

Medical treatment

Aural toilet: Debris and aural polyp should be removed before treatment.
Do not avulse an aural polyp.
Ear drops: gentamicin.
Systemic Antibiotics: Limited use only in acute exacerbation.
Medication: to keep the ear dry.
There are two types of treatment:
- The disease will recur if the primary cause is not treated first.

FAQ’S

Q. How to prevent chronic otitis media?

Ans. It can be prevented by reducing exposure to secondhand smoking, managing allergies and other respiratory allergies.

Q. What are the complications of chronic otitis media ?

Ans. The complications such as hearing loss, speech delaying, and infection may spread to nearby structures and also spread to the brain.

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